They are also not meant to do R&D. For one thing they don’t pay market rate, so their access to top talent is non-existent. For another, there’s no accountability and no “fear of death”, since the government essentially can’t run out of money. Why try to use resources wisely if you can just tax people, or if that doesn’t work, print more money, and thereby tax their children and grandchildren. No, I’d much rather this risk was compartmentalized.

Another issue is, you’re de facto giving the rest of the world a free ride on US taxpayer largesse. Even better free ride than what they’re getting now: paying a dime on the dollar for newest genetic drugs without spending any money on their development. I’d go along with that in the poor countries like India, but I see no reason whatsoever why I should be paying 5-6x as much as some dude in Western Europe, all while he tries to lecture me about their “free” healthcare. I’d much rather I paid less and they paid the same as me.